OF mental health care and mentally ill

characteristic of personality disorders

One defining characteristic of personality disorder is the intense discomfort with one’s own emotional responses to certain trigger situations. This inevitably leads

to dysfunctional behaviours. From the frantic efforts of the borderline to avoid the intense emotional distress to the cold denial and dissociation of the antisocial, the common factor is an overwhelmingly fearful, often phobic, response to their own emotions: this is described as ‘frozen terror’.

For the health care professional, it is always a good idea to keep a note of trigger situations. These will usually have some common themes that, once identified, act as arrows pointing to specific vulnerabilities. Psychotherapeutic input can then be targeted towards the relevant issues.

Another common factor is an incredibly low self-esteem. This is often the result of years of invalidating experiences, leading many people with personality disorder to believe that they are bad, worthless, evil or unacceptable in some way.

Those who suffer from this debilitating belief will often find it excruciatingly uncomfortable to receive compliments, since anything positive said about them conflicts with their established self-image. This discomfort often leads to dysfunctional behaviours, and they regard the person giving the compliment with suspicion.

For example, if you ‘know’ what someone is saying is obviously untrue, it is only logical to be suspicious as to why they are saying it.

People with personality disorder can alternate between avoiding others (because they know they will be rejected) or desperately clinging onto a relationship in an inappropriate manner in an attempt to avoid the overwhelming emotional hurt of facing rejection yet again, which will confirm all their worst fears about themselves.

Most people have felt the pain of rejection at some time in their lives. For people with personality disorder, the feelings evoked by these situations (hurt, anguish, self-loathing and despair) can be overwhelming. The fear of what they might do in these circumstances is often terrifying, and with good cause. People with personality disorder are more likely to commit suicide than any other group.

Moskovitz describes borderline personality disorder as ‘emotional haemophilia’. He suggests that if you prick a person with personality disorder emotionally they may bleed to death emotionally. It is important to recognise that once people have experienced this pain a few times they become extremely sensitive to rejection and it becomes so important to avoid it happening again that they become hypervigilant and develop strategies to predict and avoid any situation that might trigger these emotions.

Small things can trigger a huge response. Anything from not talking to them, or failing to phone as arranged, to telling them you are too busy to see them can be perceived by them as proof that they are worthless and unlovable and can trigger a response that is literally life-threatening.

This can be misunderstood by health care professionals, who perceive this as ‘acting out’ or manipulative behaviour. One common response to these behaviours is to attempt to discourage them by ignoring them. This crude behavioural response is never effective; if a client is seeking attention, it may be because they need more attention. To deprive them of attention therefore will most likely lead to more

desperate attention-seeking behaviours and may damage the therapeutic relationship.

The effect of withholding attention from the client at a time when they feel a desperate need for attention may well be to confirm their belief that no one cares and thus reinforce their underlying schema that they are worthless and not deserving of any understanding or care.

A far better strategy in these situations is to provide the necessary attention at the time, then at a time when the client is calm and secure use the incident to discuss with the client what happened and then to teach them more appropriate ways of meeting their needs when they find themselves in this type of situation.

These socioeducational interventions can be among the most helpful interventions for treating personality disorder.

People with this personality disorder are extremely sensitive. They are expert at picking up the tiniest clue such as body language or tone of voice posture or facial expression. Often, these people have an exceptional ability to pick up on others’ feelings and will often be the first to notice if a fellow service user is feeling

low, angry, suicidal or upset. Sadly, although so often accurate and understanding towards other people’s emotional turmoil, when it comes to their own they may be blinded by their negative beliefs about themselves and so closed to any interpretation

other than the worst.

Common responses to these sensitivities vary from person to person and from time to time; however, it may be useful to discuss a few behaviours that are often seen and repeated many times among this client group.